Bottom Line:
We found a virulent closely related clone (Panton-Valentine leukocidin-positive, SCCmec V:ST59) of methicillin-resistant Staphylococcus aureus in inpatients and outpatients in Taiwan.The isolates were found mostly in wounds but were also detected in blood, ear, respiratory, and other specimens; all were susceptible to ciprofloxacin, gentamicin, and trimethoprim-sulfamethoxazole.

ABSTRACTWe found a virulent closely related clone (Panton-Valentine leukocidin-positive, SCCmec V:ST59) of methicillin-resistant Staphylococcus aureus in inpatients and outpatients in Taiwan. The isolates were found mostly in wounds but were also detected in blood, ear, respiratory, and other specimens; all were susceptible to ciprofloxacin, gentamicin, and trimethoprim-sulfamethoxazole.

Mentions:
To obtain an overall understanding of MRSA throughout Taiwan, we first chose 80 MRSA isolates (68 inpatient and 12 outpatient isolates) collected in 2002 from 4 hospitals located in the north, middle, south, and east regions of Taiwan. Pulsed-field gel electrophoresis was performed according to a published protocol (9), and pulsotypes were assigned to clusters of isolates with >80% similarity from the dendrograms. SCCmec typing and PVL gene detection were performed according to published protocols (7,8,10). Multilocus sequence typing (MLST) was performed on randomly selected strains from major pulsotypes, and the sequence type (ST) was assigned by using the MLST database (http://www.mlst.net) (13). Three major clusters (pulsotypes) were found, including 47 (58.8%) pulsotype A, 7 (8.8%) pulsotype B, and 18 (22.5%) pulsotype C (Figure A1). All 47 pulsotype A isolates had SCCmec III; 4 isolates tested by MLST had ST239. In addition to being resistant to clindamycin (94%), erythromycin (100%), and tetracycline (100%), all pulsotype A isolates were resistant to ciprofloxacin (CIP), gentamicin (GEN), and trimethoprim/sulfamethoxazole (SXT). The 7 pulsotype B isolates possessed SCCmec IV but were not of the 4 known IV subtypes (IV not a–d); all were CIP- and SXT-susceptible but GEN-resistant. Seventeen of the 18 isolates in pulsotype C possessed SCCmec V; the other had SCCmec IVa; all 18 were CIP/GEN/SXT-susceptible. Of the 10 isolates tested by MLST from pulsotype B (3 isolates) and pulsotype C (7 isolates), all had ST59. Only pulsotype C isolates were PVL-positive.

Mentions:
To obtain an overall understanding of MRSA throughout Taiwan, we first chose 80 MRSA isolates (68 inpatient and 12 outpatient isolates) collected in 2002 from 4 hospitals located in the north, middle, south, and east regions of Taiwan. Pulsed-field gel electrophoresis was performed according to a published protocol (9), and pulsotypes were assigned to clusters of isolates with >80% similarity from the dendrograms. SCCmec typing and PVL gene detection were performed according to published protocols (7,8,10). Multilocus sequence typing (MLST) was performed on randomly selected strains from major pulsotypes, and the sequence type (ST) was assigned by using the MLST database (http://www.mlst.net) (13). Three major clusters (pulsotypes) were found, including 47 (58.8%) pulsotype A, 7 (8.8%) pulsotype B, and 18 (22.5%) pulsotype C (Figure A1). All 47 pulsotype A isolates had SCCmec III; 4 isolates tested by MLST had ST239. In addition to being resistant to clindamycin (94%), erythromycin (100%), and tetracycline (100%), all pulsotype A isolates were resistant to ciprofloxacin (CIP), gentamicin (GEN), and trimethoprim/sulfamethoxazole (SXT). The 7 pulsotype B isolates possessed SCCmec IV but were not of the 4 known IV subtypes (IV not a–d); all were CIP- and SXT-susceptible but GEN-resistant. Seventeen of the 18 isolates in pulsotype C possessed SCCmec V; the other had SCCmec IVa; all 18 were CIP/GEN/SXT-susceptible. Of the 10 isolates tested by MLST from pulsotype B (3 isolates) and pulsotype C (7 isolates), all had ST59. Only pulsotype C isolates were PVL-positive.

Bottom Line:
We found a virulent closely related clone (Panton-Valentine leukocidin-positive, SCCmec V:ST59) of methicillin-resistant Staphylococcus aureus in inpatients and outpatients in Taiwan.The isolates were found mostly in wounds but were also detected in blood, ear, respiratory, and other specimens; all were susceptible to ciprofloxacin, gentamicin, and trimethoprim-sulfamethoxazole.

ABSTRACTWe found a virulent closely related clone (Panton-Valentine leukocidin-positive, SCCmec V:ST59) of methicillin-resistant Staphylococcus aureus in inpatients and outpatients in Taiwan. The isolates were found mostly in wounds but were also detected in blood, ear, respiratory, and other specimens; all were susceptible to ciprofloxacin, gentamicin, and trimethoprim-sulfamethoxazole.